Alternative Approaches to Bilateral Stellate Ganglion Block for Treatment of Refractory Ventricular Arrhythmia

Patients with ventricular arrhythmias (VAs) refractory to medical treatment suffer high morbidity and mortality. The stellate ganglion block is an effective diagnostic and therapeutic tool for refractory VAs.

After obtaining an informed consent, we describe a case of a 62-year-old female who suffered ventricular tachycardia refractory to pharmacologic and electrical management, resulting in pulseless ventricular tachycardia (pVT) arrest. The regional anesthesia team was unable to expose the neck and obtain adequate ultrasound visualization using the classic approach and therefore used alternative ultrasound-guided approaches with success.

We describe the performance of the stellate ganglion blocks with an out-of-plane needle approach on the left and a medial in-plane approach on the right. These approaches allowed us to successfully block the stellate ganglia bilaterally.

Refractory VA is associated with an increased cardiac sympathetic tone and has high morbidity and mortality. Stellate ganglion blocks can be used for diagnostic and therapeutic purposes. In-plane and out-of-plane techniques can be utilized.